? Is it safe to increase?

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Jennifer and Winston

Jennifer and Winston

Member Since 2021
Good morning! We had to take Winston to the Vet on Dec. 16th because he was not himself. He was lethargic and not wanting to eat. He was treated for ketones. They kept him for two nights to give him IV fluids to flush them out. They increased his dose to 1 unit in the morning and 1.5 in the evening. I was advised to keep the dose the same in the AM and PM so, I decided to keep him at 1 unit in the AM and PM. I have been testing periodically throughout the day and night but, his numbers are still high. Is it too early for an increase?
 
I am going to tag a few people for you @tiffmaxee @Bron and Sheba (GA) @Bandit's Mom

Based on the numbers and recent ketones I would think it's ok to fast track increases a little bit but please wait for one of them to advise.

In the meantime - are you testing ketones at home? I would test daily at this point, the urine ketone strips like Ketostix from the pharmacy (no prescription needed) would be fine. Most people use a dedicate ladle to catch it, or saran wrap over the litter, etc. They also make blood ketone meters but that can be a little pricey.

How is his appetite? Fluid intake? You'll want to make sure he's getting plenty of food and water to help keep ketones away/flush them out. You can water his food down to help with water intake as well.
 
Thanks for your reply! I have the strips to test his urine but, haven't caught him in the litter box yet. I was just gifted a meter to detect ketones, I am going to try to find some strips for it today. He is hungry all the time and is drinking lots.
 
Here’s your previous post for continuity.
https://felinediabetes.com/FDMB/threads/is-it-ok-not-to-test-for-a-couple-of-days.256466/
It is very important to test enough to increase sooner. Was he dka when treated for ketones? Either way it is important to get him into better numbers as soon as possible. Looks like you did skip that one day. Did you really shot 1.5 after that? Lantus is a depot insulin and a one time increase will do nothing to make up for past skips.

It looks like you are not feeding any dry food. Would you be able to test as much as possible if you were to switch to TR to get those numbers better? It will likely take way too long with SLGS.
 
If you can get 4 tests per day - 2 preshot and 1 in each cycle (between shots), I would recommend you follow TR till you get him to a good dose. With a history of ketones/DKA, you do not want him to getting less insulin than he needs and stay in high numbers.

You are right about Lantus being dosed the same in the AM and PM, but 1U is too little for him. I would suggest you go to 1.5U twice a day and get tests to see how he is doing on that dose.
 
tiffmaxee said:
Here’s your previous post for continuity.
https://felinediabetes.com/FDMB/threads/is-it-ok-not-to-test-for-a-couple-of-days.256466/
It is very important to test enough to increase sooner. Was he dka when treated for ketones? Either way it is important to get him into better numbers as soon as possible. Looks like you did skip that one day. Did you really shot 1.5 after that? Lantus is a depot insulin and a one time increase will do nothing to make up for past skips.

It looks like you are not feeding any dry food. Would you be able to test as much as possible if you were to switch to TR to get those numbers better? It will likely take way too long with SLGS.
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He went to the vet that day(16th). I was not able to stay with him at all, only drop him off due to Covid protocol. I am not sure what dka is. He did have insulin on the 16th, but they didn't tell me how much. When I asked them to write down what they gave him and his numbers, they only gave me from the 17th on. They gave him 1.5 units, not me.
He has been tested at least 4 times a day since the 17th. Is that enough? If not, when would be the best times to test? I am willing an able to do TR.
 
Bandit's Mom said:
If you can get 4 tests per day - 2 preshot and 1 in each cycle (between shots), I would recommend you follow TR till you get him to a good dose. With a history of ketones/DKA, you do not want him to getting less insulin than he needs and stay in high numbers.

You are right about Lantus being dosed the same in the AM and PM, but 1U is too little for him. I would suggest you go to 1.5U twice a day and get tests to see how he is doing on that dose.
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Ok, thank you! I will give him 1.5u tonight then? What is the best time to test after pre shot?
 
Most cats onset (lantus starts to work) around +2, two hours after the shot. If that number is the lower than the preshot you might have an active cycle. A +1 will let you know how much of a food bump he gets but not necessary right now given his bg numbers.
 
I agree with increasing to 1.5 units twice a day. If you can get some more mid cycle tests in that would be helpful…. Including the PM cycles.

I would continue to test daily for ketones in the urine and if you could put the result into the remarks column of the SS that would help Us see how he’s going.

Also food is very important where ketones are in the picture so I would encourage you to give him a snack of food every 2 hours as we want him to be eating more than normal to combat any ketones.

If he will accept a teaspoon of warm water in each snack of food that will increase his fluid intake which is also important to flush out any ketones.
 
tiffmaxee said:
Most cats onset (lantus starts to work) around +2, two hours after the shot. If that number is the lower than the preshot you might have an active cycle. A +1 will let you know how much of a food bump he gets but not necessary right now given his bg numbers.
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ok, thank you! His PM +2 was 19. I will check again in a couple of hours.
 
Bron and Sheba (GA) said:
I agree with increasing to 1.5 units twice a day. If you can get some more mid cycle tests in that would be helpful…. Including the PM cycles.

I would continue to test daily for ketones in the urine and if you could put the result into the remarks column of the SS that would help Us see how he’s going.

Also food is very important where ketones are in the picture so I would encourage you to give him a snack of food every 2 hours as we want him to be eating more than normal to combat any ketones.

If he will accept a teaspoon of warm water in each snack of food that will increase his fluid intake which is also important to flush out any ketones.
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ok, great advice! Thank you!
 
Jennifer -

Your spreadsheet looks like you dosed 1.0u today at AMPS. I'm hoping this was a typo and you actually gave 1.5u. Lantus does best if the AM and PM doses are the same as you mentioned above.

I'd also encourage you to start posting on the Lantus/Lev/Biosimilar board. There's a huge amount of experience there with Lantus.
 
Sienne and Gabby (GA) said:
Jennifer -

Your spreadsheet looks like you dosed 1.0u today at AMPS. I'm hoping this was a typo and you actually gave 1.5u. Lantus does best if the AM and PM doses are the same as you mentioned above.

I'd also encourage you to start posting on the Lantus/Lev/Biosimilar board. There's a huge amount of experience there with Lantus.
Click to expand...
Oh gosh, yes, that was a typo! Thank you, I will check it out!
 
Hi Jennifer I see on your spreadsheet you switched to TR , can you please change that in your signature . Good luck :cat: You can put TR and the date you switched
 
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